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General NPI Number Information
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NPI Number | 1609030634
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Entity Type | Individual
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Provider Name | MATTHEW ADAM TESTRAKE DPM
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Gender | Male
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Dates
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Enumeration Date | 07/18/2008
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 120 E 2ND ST 4TH FLOOR
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City | ERIE
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State | PA
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Zip | 16507-1537
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Country | US
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Telephone | 814-877-3668
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Fax | 814-877-3624
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Provider Business Mailing Address
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Address Line | 9500 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-444-9500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36.003538
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License Number State | OH
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